Understanding Pathology Results

Question:  Can you help me understand this report?
Breast Right, biospy:
Infiltrating ductal carcinoma
SBR/Nottingham grade 2/3
Tubular score 2.
Nuclear score 2.
Mitotic score 2 (focal).
No evidence of angiolymphatic invasion
Cancerization og lobules
Ductal carcinoma in situ
Solid, papillary and cribriform patterns
Nuclear grade 2-3
Comedonecrosis present
Microcalcifications associated with in situ malignancy
Immunostains -
Estrogen receptor – diffuse strong positivity in 97% of tumor cell nuclei
Progesterone receptor – rare positive tumor cell nuclei (less than1 %)
Ki67 – diffuse strong positivity in 20% of tumor cell nuclei
E cadherin – strong positivityHer2neu – pending
I am 41 years old.  Height 5’2″  weight 110, run few miles every other day.  I have two wonderful children ages 11 and 12 and an awesome husband of 21 years.  Please help me to make decisions on who would be best in helping me.

Answer:  I am assuming based on your report and the absence of a comment on surgical margins that this was a core needle biopsy. Is that correct?

Your report indicates that you have an intermediate grade invasive mammary carcinoma that is not lobular (that’s what the e-cadherin strongly positive stain means — invasive lobular carcinomas are generally e-cadherin negative). Having associated ductal carcinoma in situ (DCIS) is very common. Cancerization of lobules just means the DCIS is extending into the lobules of the breast and really has no clinical significance in this case. It is good that your tumor is strongly estrogen receptor positive.  The report on the progesterone receptor stain says less than 1% positive which means negative (1% is the cut-off). The lack of angiolymphatic invasion is also a good thing. Ki-67 is a stain that indicates how fast the tumor is replicating. 20% is an arbitrary cut off point for a high proliferation rate but there isn’t a lot of data on whether this alone is significant.

If this was a core needle biopsy, you will need surgical excision (lumpectomy or mastectomy) with a sentinel node biopsy at some point. Without information on the her2/neu status of your tumor and the size and whether or not your sentinel node(s) are positive I cannot comment on your stage or whether chemotherapy will be recommended.

If you can go to a breast center that has a multi-disciplinary clinic that might be a good next step. At multi-disciplinary clinics specialists from many fields (surgeons, radiologists, pathologists, medical oncologists, and radiation oncologists) meet and discuss your particular case and make recommendations.

Best wishes and write back if you receive more information and have more questions.

Leave a Reply